Genetic generalized epilepsy and generalized onset seizures with focal evolution (GOFE)

Lamy, F.; Valenti‐Hirsch, Maria‐Paola; Gauer, Lucas; Gérard, Bénédicte; Obeid, Mohamed A.; Saint‐Martin, Anne de; Dinkelacker, Vera; Baer, Sarah; Hirsch, Édouard

doi:10.1016/j.ebr.2022.100555

Cited by 3 publications

(2 citation statements)

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“…36 This ictal pattern was characterized as an uncommon phenomenon, 43 with some authors proposing that it might represent a distinct subgroup of genetic or idiopathic generalized epilepsy. 44 In accordance with our findings, the focal discharges were most often located at the temporal and frontal regions and mainly in the theta or frequency band. 36 Our study extends the existing observations, showing that ictal propagation of generalized onset seizures may be present in idiopathic generalized epilepsy syndromes, it is more common than previously described, and it may be associated with a focal clinical pattern of head version.…”

Section: Discussionsupporting

confidence: 92%

“…Other studies reporting versive seizures in IGE 5,41,42 did not describe this EEG pattern. Although the focal propagation of generalized onset seizures has previously been highlighted, 36,43,44 the existing literature reports only a limited number of cases, with heterogeneous population/ different generalized seizure types (absence, myoclonic, GTCS), 36 with epilepsy onset age before the first year of life, 43 or patients presenting with positive MRI findings or with cognitive impairment. 36 This ictal pattern was characterized as an uncommon phenomenon, 43 with some authors proposing that it might represent a distinct subgroup of genetic or idiopathic generalized epilepsy.…”

Section: Discussionmentioning

confidence: 99%

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Focal electroclinical features in generalized tonic–clonic seizures: Decision flowchart for a diagnostic challenge

Vlachou,

Ryvlin,

Armand Larsen

et al. 2024

Epilepsia

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ObjectiveBilateral tonic–clonic seizures with focal semiology or focal interictal electroencephalography (EEG) can occur in both focal and generalized epilepsy types, leading to diagnostic errors and inappropriate therapy. We investigated the prevalence and prognostic values of focal features in patients with idiopathic generalized epilepsy (IGE), and we propose a decision flowchart to distinguish between focal and generalized epilepsy in patients with bilateral tonic–clonic seizures and focal EEG or semiology.MethodsWe retrospectively analyzed video‐EEG recordings of 101 bilateral tonic–clonic seizures from 60 patients (18 with IGE, 42 with focal epilepsy). Diagnosis and therapeutic response were extracted after ≥1‐year follow‐up. The decision flowchart was based on previous observations and assessed concordance between interictal and ictal EEG.ResultsFocal semiology in IGE was observed in 75% of seizures and 77.8% of patients, most often corresponding to forced head version (66.7%). In patients with multiple seizures, direction of head version was consistent across seizures. Focal interictal epileptiform discharges (IEDs) were observed in 61.1% of patients with IGE, whereas focal ictal EEG onset only occurred in 13% of seizures and 16.7% of patients. However, later during the seizures, a reproducible pattern of 7‐Hz lateralized ictal rhythm was observed in 56% of seizures, associated with contralateral head version. We did not find correlation between presence of focal features and therapeutic response in IGE patients. Our decision flowchart distinguished between focal and generalized epilepsy in patients with bilateral tonic–clonic seizures and focal features with an accuracy of 96.6%.SignificanceFocal semiology associated with bilateral tonic–clonic seizures and focal IEDs are common features in patients with IGE, but focal ictal EEG onset is rare. None of these focal findings appears to influence therapeutic response. By assessing the concordance between interictal and ictal EEG findings, one can accurately distinguish between focal and generalized epilepsies.

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